Monday

Interact with experts in the field during these smaller, less formal 90-minute sessions. Interesting cases on specific topics, similar to cases being reviewed in a hospital on a multiheaded microscope are reviewed using a video microscope.

Educational Objectives:
1. Develop the skills to generate a differential diagnosis based on the exhibited cytological pattern and to establish the diagnosis based on specific cytological features
2. Recognize lesions that masquerade as malignancies and be familiar with their mimicking and distinguishing features
3. Develop the skills to resolve diagnostically difficult cases and avoid errors

Cytology of lung specimens presents unique diagnostic challenges and is among the most frequent source of medico-legal action in non-gynecologic specimens. This tutorial will focus on both benign and malignant mimickers that could contribute to serious false diagnoses or misclassification. Discussion will include: benign lesions such as pneumocyte hyperplasia, organizing pneumonia and granulomatous lesions versus adenocarcinoma, basal cell hyperplasia versus small cell carcinoma, viral and therapy induced cytopathic changes versus malignancy etc. as well as malignant tumors with subtle features masquerading as benign such as adenocarcinoma with bronchoalveolar growth pattern, bronchial associated lymphoma etc.

Educational Objectives:
1. Discuss the problem of analytical resolution in clinical laboratory testing
2. Review processes that worsen morphologic resolution including: metaplasia, degeneration, inflammation, repair and other forms of cellular stimulation
3. Show that the work of important authors of the past can bring clarity to what continues to be a source of insecurity
4. Improve efficiency of daily work-life in gynecologic cytology by attempting to set boundaries on the ASC-US category

In cervical cytology the “gray zone” of Atypical Cells of Uncertain Significance (ASC-US) continues to be a source of frustration for cytologists, clinicians and patients. It is well known that a strictly morphologic analysis cannot totally resolve the diseased and the non-diseased population when evaluating the cytology of the uterine cervix for neoplasia. ASC-US has shown itself to have reproducibility problems between institutions, within institutions and within a given observer. Nonetheless, there are basic principles in the evaluation of cervical cytology given to us by historical figures such as Drs. Stanley Patten and John Frost that can let us know when we are in the realm of ASC-US. Principles that can tell us “when to make the call” and move on to the next case. In this Video Microscopy Tutorial we intend to talk about many of those principles and display numerous examples. Patterns and themes of cellular alterations that interfere with our ability to bring clarity to the Pap test will be discussed. We intend to deal with the pain of metaplasia, the perversity of parakeratosis, the problem of degeneration, and enhance our interpretive efficiency.

Educational Objectives:
1. Recognize and apply morphologic criteria to diagnose thyroid disease and identify diagnostic issues and limitations
2. Understand The Bethesda System for Reporting Thyroid Cytopathology
3. Appreciate the clinical implications of cytologic interpretations and be familiar with management guidelines of each diagnostic category

Thyroid Fine Needle Aspiration is one of the most commonly performed procedures in non-gynecologic cytopathology. The Bethesda System for Reporting Thyroid Cytopathology, “TBSRTC” (or simply “Thyroid-TBS”) was introduced to develop a robust and reproducible reporting system, obviate inconsistencies in terminology for thyroid FNAs and provide management guidelines for the treating physicians. The tutorial will elaborate on the terminology issues and morphologic criteria from the Thyroid atlas project that form the framework for the TBSRTC. By illustrating each diagnostic category of TBS with selected examples of cases with direct-smear glass slides, the presentation will facilitate the understanding and application of the six diagnostic categories. Emphasis will be placed on accurate identification of morphologic clues, awareness of potential pitfalls and phrasing/wording the final report as recommended by TBS. The presentation format will be interactive and ample time will be available for Q&A.

Educational Objectives:
1. Demonstrate how to make a diagnosis of a lymphoproliferative lesion using cytologic material in the context of the 2008 WHO lymphoma classification.
2. Provide an update on the new entities recognized in the 2008 WHO lymphoma classification and their cytomorphologic presentation

The use of cytology specimens, particularly FNAs, to diagnose lymphoproliferative lesions continue to grow as more studies can be performed with less material. The 2008 WHO lymphoma classification has introduced several new entities with special attention given to site and age. Some of the newly recognized entities have unique characteristics that might make an accurate cytology diagnosis difficult even with the use of the usual immunocytochemical or flow cytometry markers. The tutorial will provide useful information how to make the diagnosis of lymphoid lesions in the context of the 2008 WHO lymphoma classification and how to address the newly recognized entities. Special attention will be given to potential pitfalls in the diagnosis of the lymphomas with unique phenotype.

Pancreatic cancer is among the top 10 leading causes of cancer-associated deaths in the United States. It is reported that resection of early (size <3.0 cm) organ-confined tumors provide significantly improved patient survival. Endoscopic ultrasound (EUS) is superior to CT scans and MRI in detecting smaller pancreatic lesions. While imaging studies are important to detect the lesion, tissue diagnosis still remains the gold standard. The success of EUS-FNA in diagnosing pancreatic lesions has changed the practice for obtaining pre-operative diagnosis. Intrinsically, the EUS-FNA specimens from the pancreas are difficult to approach and interpret. A simple morphology-based algorithm to approach these specimens would be of immense help, which has not been previously described in the literature. During this course, a morphology-based practical algorithm will be used to arrive at the diagnosis for common and uncommon pancreatic diseases.

Educational Objectives:
1. Understand the spectrum of soft tissue lesions/pathology encountered in practice
2. Discuss the approach to be taken at the time of adequacy evaluation and triage for specialized testing
3. Familiarize the audience with the general diagnostic approach towards soft tissue lesions
4. Understand the limitations and pitfalls in soft tissue cytology and strategies to avoid them

This video microscopy tutorial will present an approach to the evaluation, triage and diagnosis of soft tissue fine needle aspiration and touch preparations of core needle biopsies with cytology histology correlation. An algorithmic approach to the interpretation of primary soft tissue neoplasm, both benign and malignant, will also be discussed in a case presentation format. Triage at the time of adequacy evaluation and special studies including appropriate molecular testing will also be discussed.